Hib vaccine

Last updated

Hib vaccine
Vaccine description
Target disease Haemophilus influenzae type b
Type Conjugate vaccine
Clinical data
Trade names ActHIB, Hiberix, OmniHIB, others
AHFS/Drugs.com Professional Drug Facts
MedlinePlus a607015
License data
Pregnancy
category
Routes of
administration
IM
ATC code
Legal status
Legal status
Identifiers
DrugBank
ChemSpider
  • none
UNII
 X mark.svgNYes check.svgY  (what is this?)    (verify)
Hib vaccine
Identifiers
DrugBank
UNII

The Haemophilus influenzae type B vaccine, often called Hib vaccine, is a vaccine used to prevent Haemophilus influenzae type b (Hib) infection. [2] In countries that include it as a routine vaccine, rates of severe Hib infections have decreased more than 90%. [2] It has therefore resulted in a decrease in the rate of meningitis, pneumonia, and epiglottitis. [2]

Contents

It is recommended by both the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). [2] [3] Two or three doses should be given before six months of age. [2] In the United States a fourth dose is recommended between 12 and 15 months of age. [4] The first dose is recommended around six weeks of age with at least four weeks between doses. [2] If only two doses are used, another dose later in life is recommended. [2] It is given by injection into a muscle. [2]

Severe side effects are extremely rare. [2] About 20 to 25% of people develop pain at the site of injection while about 2% develop a fever. [2] There is no clear association with severe allergic reactions. [2] The Hib vaccine is available by itself, in combination with the diphtheria/tetanus/pertussis vaccine, and in combination with the hepatitis B vaccine, among others. [2] All Hib vaccines that are currently used are conjugate vaccine. [2]

An initial Hib vaccine was developed in 1977, which was replaced by a more effective formulation in the 1990s. [2] As of 2013, 184 countries include it in their routine vaccinations. [2] It is on the World Health Organization's List of Essential Medicines. [5]

Medical uses

Hib conjugate vaccines have been shown to be universally effective against all manifestations of Hib disease, with a clinical efficacy among fully vaccinated children estimated to be between 95–100%. The vaccine has also been shown to be immunogenic in patients at high risk of invasive disease. Hib vaccine is not effective against non-type B Haemophilus influenzae. However, non-type B disease is rare in comparison to pre-vaccine rates of Haemophilus influenzae type B disease. [6]

Impact

Prior to introduction of the conjugate vaccine, Hib was a leading cause of childhood meningitis, pneumonia, and epiglottitis in the United States, causing an estimated 20,000 cases a year in the early 1980s, mostly in children under five years old. Since routine vaccination began, the incidence of Hib disease has declined by greater than 99%, effectively eliminating Hib as a public health problem. Similar reductions in disease occurred after introduction of the vaccine in Western Europe and developing countries.[ citation needed ]

After routine use of the vaccine in the United States from 1980 to 1990, the rate of invasive Hib disease decreased from 40–100 per 100,000 children down to fewer than one per 100,000. [7]

Recommendations

The CDC and the WHO recommend that all infants be vaccinated using a polysaccharide-protein conjugate Hib vaccine, starting after the age of six weeks. The vaccination is also indicated in people without a spleen. [8]

Side effects

Clinical trials and ongoing surveillance have shown Hib vaccine to be safe. In general, adverse reactions to the vaccine are mild. The most common reactions are mild fever, loss of appetite, transient redness, swelling, or pain at the site of injection, occurring in 5–30% of vaccine recipients. More severe reactions are extremely rare. [6]

Mechanisms of action

Polysaccharide vaccine

Haemophilus influenzae type b is a bacterium with a polysaccharide capsule; the main component of this capsule is polyribosyl ribitol phosphate (PRP). Anti-PRP antibodies have a protective effect against Hib infections. Thus, purified PRP was considered a good candidate for a vaccine. However, the antibody response to PRP diminished rapidly after administration. This problem was due to recognition of the PRP antigen by B cells, but not T cells. In other words, even though B cell recognition was taking place, T cell recruitment (via MHC class II) was not, which compromised the immune response. This interaction with only B cells is termed T-independent (TI). This process also inhibits the formation of memory B cells, thus compromising long term immune system memory. [9] [10]

Conjugate vaccine

PRP covalently linked to a protein carrier was found to elicit a greater immune response than the polysaccharide form of the vaccine. This is due to the protein carrier being highly immunogenic in nature. The conjugate formulations show responses which are consistent with T-cell recruitment (namely a much stronger immune response). A memory effect (priming of the immune system against future attack by Hib) is also observed after administration; indicative that memory B cell formation is also improved over that of the polysaccharide form. Since optimal contact between B cells and T cells is required (via MHC II) to maximize antibody production, it is reasoned that the conjugate vaccine allows B cells to properly recruit T cells, this is in contrast to the polysaccharide form in which it is speculated that B cells do not interact optimally with T cells leading to the TI interaction. [9] [10]

Developing world

Introduction of Hib vaccine in developing countries lagged behind that in developed countries for several reasons. The expense of the vaccine was large in comparison to the standard EPI vaccines. Poor disease surveillance systems and inadequate hospital laboratories failed to detect the disease, leading many experts to believe that Hib did not exist in their countries. And health systems in many countries were struggling with the current vaccines they were trying to deliver.

GAVI and the Hib Initiative

In order to remedy these issues, the GAVI Alliance took active interest in the vaccine. GAVI offers substantial subsidization of Hib vaccine for countries interested in using the vaccine, as well as financial support for vaccine systems and safe injections. In addition, GAVI created the Hib Initiative to catalyze uptake of the vaccine. The Hib Initiative uses a combination of collecting and disseminating existing data, research, and advocacy to assist countries in the making a decision about using the Hib vaccine. Currently, 61 out of 72 low-income countries are planning on introducing the vaccine by the end of 2009. [11]

History

Polysaccharide vaccine

The first Hib vaccine licensed was a pure polysaccharide vaccine, first marketed in the United States in 1985. [12] Similar to other polysaccharide vaccines, immune response to the vaccine was highly age-dependent. Children under 18 months of age did not produce a positive response for this vaccine. As a result, the age group with the highest incidence of Hib disease was unprotected, limiting the usefulness of the vaccine. The vaccine was withdrawn from the market in 1988.[ citation needed ]

Conjugate vaccine

The shortcomings of the polysaccharide vaccine led to the production of the Hib polysaccharide-protein conjugate vaccine. [12] The first such vaccine available in the United States was based on work done by American scientists John Robbins and Rachel Schneerson [13] and was available in 1987. Attaching Hib polysaccharide to a protein carrier greatly increased the ability of the immune system of young children to recognize the polysaccharide and develop immunity. There are currently three types of conjugate vaccine, utilizing different carrier proteins for the conjugation process: inactivated tetanospasmin (also called tetanus toxoid); mutant diphtheria protein; and meningococcal group B outer membrane protein. [14]

Combination vaccines

Multiple combinations of Hib and other vaccines have been licensed in the United States, reducing the number of injections necessary to vaccinate a child. Hib vaccine combined with diphtheria-tetanus-pertussispolio vaccines and Hepatitis B vaccines are available in the United States. The World Health Organization (WHO) has certified several Hib vaccine combinations, including a pentavalent diphtheria-pertussis-tetanus-hepatitis B-Hib, for use in developing countries. There is not yet sufficient evidence on how effective this combined pentavalent vaccine is in relation to the individual vaccines. [15]

Related Research Articles

ATC code J07Vaccines is a therapeutic subgroup of the Anatomical Therapeutic Chemical Classification System, a system of alphanumeric codes developed by the World Health Organization (WHO) for the classification of drugs and other medical products. Subgroup J07 is part of the anatomical group J Antiinfectives for systemic use.

DPT vaccine

The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis, and tetanus. The vaccine components include diphtheria and tetanus toxoids and either killed whole cells of the bacterium that causes pertussis or pertussis antigens. The whole cells or antigens will be depicted as either "DTwP" or "DTaP", where the lower-case "w" indicates whole-cell inactivated pertussis and the lower-case "a" indicates pertussis antigens.

<i>Haemophilus influenzae</i> Species of bacterium

Haemophilus influenzae is a Gram-negative, coccobacillary, facultatively anaerobic capnophilic pathogenic bacterium of the family Pasteurellaceae. H. influenzae was first described in 1892 by Richard Pfeiffer during an influenza pandemic.

Conjugate vaccine

A conjugate vaccine is a type of vaccine which combines a weak antigen with a strong antigen as a carrier so that the immune system has a stronger response to the weak antigen.

Immunization during pregnancy, that is the administration of a vaccine to a pregnant woman, is not a routine event as it is generally preferred to administer vaccines either prior to conception or in the postpartum period. When widespread vaccination is used, the risk for an unvaccinated pregnant patient to be exposed to a related infection is low, allowing for postponement, in general, of routine vaccinations to the postpartum period. Nevertheless, immunization during pregnancy may occur either inadvertently, or be indicated in a special situation, when it appears prudent to reduce the risk of a specific disease for a potentially exposed pregnant woman or her fetus.

Hepatitis B vaccine

Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people routine immunization results in more than 95% of people being protected.

The Expanded Program on Immunization is a World Health Organization program with the goal to make vaccines available to all children.

Diphtheria vaccine

Diphtheria vaccine is a toxoid vaccine against diphtheria, an illness caused by Corynebacterium diphtheriae. Its use has resulted in a more than 90% decrease in number of cases globally between 1980 and 2000. The first dose is recommended at six weeks of age with two additional doses four weeks apart, after which it is about 95% effective during childhood. Three further doses are recommended during childhood. It is unclear if further doses later in life are needed.

Pertussis vaccine Vaccine protecting against whooping cough

Pertussis vaccine is a vaccine that protects against whooping cough (pertussis). There are two main types: whole-cell vaccines and acellular vaccines. The whole-cell vaccine is about 78% effective while the acellular vaccine is 71–85% effective. The effectiveness of the vaccines appears to decrease by between 2 and 10% per year after vaccination with a more rapid decrease with the acellular vaccines. The vaccine is only available in combination with tetanus and diphtheria vaccines. Pertussis vaccine is estimated to have saved over 500,000 lives in 2002.

A vaccine-preventable disease is an infectious disease for which an effective preventive vaccine exists. If a person acquires a vaccine-preventable disease and dies from it, the death is considered a vaccine-preventable death.

A Vaccine Information Statement (VIS) is a document designed by the Centers for Disease Control and Prevention (CDC) to provide information to a patient receiving a vaccine in the United States. The National Childhood Vaccine Injury Act requires that medical professionals provide a VIS to patients before receiving certain vaccinations. The VIS includes information about the vaccine's benefits and risks, a description of the vaccine, indications and contraindications, instructions for patients experiencing an adverse reaction, and additional resources.

Tetanus vaccine

Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus. During childhood, five doses are recommended, with a sixth given during adolescence.

A pentavalent vaccine, also known as a 5-in-1 vaccine, is a combination vaccine with five individual vaccines conjugated into one.

DTaP-IPV/Hib vaccine is a 5-in-1 combination vaccine that protects against diphtheria, tetanus, whooping cough, polio, and Haemophilus influenzae type B.

DPT-Hib vaccine is a combination vaccine whose generic name is diphtheria and tetanus toxoids and whole-cell pertussis vaccine adsorbed with Hib conjugate vaccine, sometimes abbreviated to DPT-Hib. It protects against the infectious diseases diphtheria, tetanus, pertussis, and Haemophilus influenzae type B.

DTaP-Hib vaccine is a combination vaccine whose generic name is diphtheria and tetanus toxoids and acellular pertussis adsorbed with Haemophilus B conjugate vaccine, sometimes abbreviated to DTaP-Hib. It protects against the infectious diseases diphtheria, tetanus, pertussis, and Haemophilus influenzae type B.

Hexavalent vaccine

A hexavalent vaccine, or 6-in-1 vaccine, is a combination vaccine with six individual vaccines conjugated into one, intended to protect people from multiple diseases. The term usually refers to the children's vaccine that protects against diphtheria, tetanus, pertussis, poliomyelitis, haemophilus B, and hepatitis B, which is used in more than 90 countries around the world including in Europe, Canada, Australia, and New Zealand.

DTP-HepB vaccine is a combination vaccine whose generic name is diphtheria and tetanus toxoids and whole-cell pertussis and hepatitis B (recombinant) vaccine (adsorbed) or DTP-Hep B. It protects against the infectious diseases diphtheria, tetanus, pertussis, and hepatitis B.

National Immunisation Program Schedule

The Australian National Immunisation Program Schedule sets out the immunisations Australians are given at different stages in their life. The program aims to reduce the number of preventable disease cases in Australia by increasing national immunisation coverage. The program starts for an Australian when they are born. Vaccinations are given at birth, then again when the baby is 2 months, 4 months, 6 months, 12 months and 18 months. The immunisation schedule continues when the child is 4 years old, and then into adolescent years. The program is not compulsory and parents have the choice if they want their child vaccinated.

References

  1. Professional Drug Facts
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 World Health Organization (September 2013). "Haemophilus influenzae type b (Hib) Vaccination Position Paper — July 2013". Weekly Epidemiological Record. 88 (39): 413–26. hdl:10665/242126. PMID   24143842. Lay summary (PDF).
  3. "Haemophilus b Conjugate Vaccines for Prevention of Haemophilus influenzae Type b Disease Among Infants and Children Two Months of Age and Older Recommendations of the ACIP". Morbidity and Mortality Weekly Report. Recommendations and Reports. 40 (RR-1): 1–7. 11 January 1991. PMID   1899280.
  4. "Hib (Haemophilus Influenzae Type B)". Archived from the original on 8 April 2016. Retrieved 30 March 2016.
  5. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  6. 1 2 Centers for Disease Control (25 June 1982). "Recommendation of the Immunization Practices Advisory Committee (ACIP). Inactivated hepatitis B virus vaccine". Morbidity and Mortality Weekly Report. 31 (24): 317–22, 327–8. PMID   6811846.
  7. "Haemophilus influenzae Disease (Including Hib)". U.S. Centers for Disease Control and Prevention (CDC). 25 September 2012. Archived from the original on 30 January 2014. Retrieved 31 January 2014.
  8. "Asplenia and Adult Vaccination". U.S. Centers for Disease Control and Prevention (CDC). 14 February 2019. Retrieved 29 March 2019.
  9. 1 2 Kelly, Dominic F.; Moxon, E. Richard; Pollard, Andrew J. (October 2004). "Haemophilus influenzae type b conjugate vaccines". Immunology. 113 (2): 163–174. doi:10.1111/j.1365-2567.2004.01971.x. PMC   1782565 . PMID   15379976.
  10. 1 2 Finn, Adam (1 January 2004). "Bacterial polysaccharide–protein conjugate vaccines". British Medical Bulletin. 70 (1): 1–14. doi: 10.1093/bmb/ldh021 . PMID   15339854.
  11. "Hib Initiative". Archived from the original on 5 September 2008. Retrieved 3 October 2008. 61 of 72 GAVI countries have introduced or will introduce Hib vaccine into their routine immunization program [ sic ] by 2009
  12. 1 2 Centers for Disease Control and Prevention (2006). Atkinson W, Hamborsky J, McIntyre L, Wolfe S (eds.). Epidemiology and Prevention of Vaccine-Preventable Diseases (9th ed.). Washington, D.C.: Public Health Foundation.
  13. https://www.historyofvaccines.org/content/articles/haemophilus-influenzae-type-b-hib
  14. Kelly, Dominic F; Moxon, E Richard; Pollard, Andrew J (October 2004). "Haemophilus influenzae type b conjugate vaccines". Immunology. 113 (2): 163–174. doi:10.1111/j.1365-2567.2004.01971.x. PMC   1782565 . PMID   15379976.
  15. Bar-On, Edna S; Goldberg, Elad; Hellmann, Sarah; Leibovici, Leonard (18 April 2012). "Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB)". Cochrane Database of Systematic Reviews (4): CD005530. doi:10.1002/14651858.CD005530.pub3. PMID   22513932.

Further reading

External sources